Brachioradial pruritus L29.9

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Brachioradial itching; Brachioradial Pruritus; Brachioradial solar pruritus; BRP

Definition
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Chronic (>6 weeks persistent = definition of chronic itching), mainly on the extensor forearms localized, mostly bilateral neuropathic itching (possibly combined with paresthesia).

Etiopathogenesis
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The accused are degenerative changes of the cervical spine (C5-C8).

In about 30% of the patients nerve compressions due to disc protrusions or stenoses of the foramina were detected.

Prolonged exposure to UV light may be an additional trigger factor.

Manifestation
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Mean age at first onset of itching 59J (12-84 years); in men the age is slightly higher at 60.5 years; w:m=8:2 (Masuda PY et al. 2013);

Localization
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Occurring on extremities, especially hands and feet and on the extensor sides of the forearms (and lower legs).

Clinical features
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Chronic, mostly bilateral (75%), very unpleasant, rather stinging, predominantly intermittent, rarely continuous itching, which is answered by the affected persons with rubbing (not scratching or pinching).

Often seasonally increased, especially in the summer months after prolonged UV-irradiation (in larger collectives in about 50% of those affected).

No visible changes of the skin (see Notalgia paresthetica).

A diagnostically valuable sign is the "ice pack sign", a clear alleviation of itching under cold application.

Arterial hypertension and depression are reported as comorbidities.

Imaging
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The most frequent radiological changes concern the spinal column (C4-C5, C7/T1): stenosis of the intervertebral spaces (about 75% of those affected) and osteophytosis (about 60%).

Histology
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The histological picture is not leading the way. Apart from actinic elastosis, the findings are "normal". Experimental: Reduction of the intraepidermal nerve fibres, especially those sensitive to calcitonin.

Therapy
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Treatment of the causing spinal nerve compression.

Moderate success (about 30% of patients respond) has been reported with administration of gabapentin or carbamazepine (alternative: lamotrigine).

  • Gabapentin: Adults: dosage within 3 days (day 1: once/day 300 mg p.o., day 2: twice/day 300 mg, day 3: three times/day 300 mg p.o.). Alternatively: initial dose 900 mg/day in 3 equal ED, maximum total dose: 3600 mg.
  • Carbamazepine: Adults: General daily dosage range: 400-1200 mg. Total daily dose of 1600 mg should not be exceeded. Therapeutic carbamazepine levels: experience shows between 4 and 12 μg/ml.

External therapy
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Successes are achieved with capsaicin ointment(e.g. dolenone, capsamol) over a treatment period of several months. Application of capsaicin is unpleasant due to burning, itching etc. in the first days (inform the patient!). Improvement can also be achieved with local anaesthetic creams (e.g. EMLA cream). Treatments with Physiogel AI cream or antipruriginous substances such as camphor or menthol (e.g. menthol solution as a prescription or Pruricalm as a ready-to-use drug) can be tried.

Note(s)
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Clarification of degenerative spinal column changes by CT or MRT.

Literature
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  1. Ally MS et al (2013) The use of aprepitant in brachioradial pruritus. JAMA Dermatol 149:627-628
  2. Barry R, Rogers S (2004) Brachioradial pruritus--an enigmatic entity. Clin Exp Dermatol 29: 637-638
  3. Bernhard JD, Bordeaux JS (2005) Medical pearl: the ice-pack sign in brachioradial pruritus. J Am Acad Dermatol 52: 1073
  4. Masuda PY et al (2013) Brachioradial pruritus -- descriptive analysis of Brazilian case series.
  5. J Dtsch Dermatol Ges 11:530-535.
  6. Mirzoyev SA et al. (2013) Brachioradial pruritus: Mayo Clinic experience over the past decade. Br J Dermatol 169:1007-1015
  7. Savk E, Savk SO (2004) On brachioradial pruritus and notalgia paresthetica. J Am Acad Dermatol 50: 800-801
  8. Wallengren J, Sundler F (2005) Brachioradial pruritus is associated with a reduction in cutaneous innervation that normalizes during the symptom-free remissions. J Am Acad 52: 142-145
  9. Weinberg BD et al (2018) Brachioradial pruritus treated with computed tomography-guided cervical nerve root block: A case series. JAAD Case Rep 4:640-644.
  10. Yosipovitch G et al (2008) Neuropathic and psychogenic itch. Dermatologic Therapy 21: 32-41

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Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020